2020-11-13T15:32:32-06:00 2019-12-31 381357951 PLANTE & MORAN PLLC 250 S HIGH ST SUITE 100 COLUMBUS OH 43215 990 2019-01-01 341352875 LIFECARE HOSPICE LIFE 3302644899 1900 AKRON ROAD WOOSTER OH 44691 CALVIN W ROBINSON CFO CFO 3302644899 2020-11-12 1 AMY CIMINELLO P00796388 6148493000 2020-11-09 76.196.244.133 2020-11-12 09:58:33 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 A37BA3EEF2DF157CE517102B87C1825C045A57BE 2019 2021-01-29 14:40:06Z KURT HOLMES 1900 AKRON ROAD WOOSTER OH 44691 11988244 0 X WWW.LIFECAREHOSPICE.COM X 1980 OH THE MISSION OF HOSPICE IS TO PROVIDE MEDICAL CARE, NURSING CARE, PAIN RELIEF, AND EMOTIONAL AND SPIRITUAL SUPPORT SERVICES TO TERMINALLY ILL PATIENTS AND THEIR FAMILIES. 10 9 165 198 0 0 657582 686895 9814460 11278579 62 -830 -3825 -1120 10468279 11963524 0 0 0 0 7389037 8328808 0 0 114999 4601179 4789423 11990216 13118231 -1521937 -1154707 13970059 13817750 9504819 10369222 4465240 3448528 THE MISSION OF HOSPICE IS TO PROVIDE MEDICAL CARE, NURSING CARE, PAIN RELIEF, AND EMOTIONAL AND SPIRITUAL SUPPORT SERVICES TO TERMINALLY ILL PATIENTS AND THEIR FAMILIES. 0 0 10214041 0 11292946 LIFECARE HOSPICE IS COMMITTED TO BEING THE PREMIER PROVIDER DEDICATED TO PRESERVING THE QUALITY OF LIFE BY PROVIDING EXPERT PHYSICAL, EMOTIONAL, AND SPIRITUAL CARE TO PATIENTS AND FAMILIES WITH LIFE-LIMITING ILLNESSES. 10214041 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 0 1 0 0 0 1 59 0 1 165 1 0 0 0 0 0 0 0 0 0 0 0 0 X 10 9 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X CALVIN W ROBINSON 3302644899 7575 PARAGON ROAD DAYTON OH 45459 KENT ANDERSON PRESIDENT & CEO - OHI 2.00 38.00 X 0 472400 63733 CALVIN W ROBINSON CHIEF FINANCIAL OFFICER - OHI 2.00 38.00 X 0 247587 63863 DAVID LANCE MEDICAL DIRECTOR LIFECARE HOSPICE 40.00 0.00 X 209993 0 31413 KURT HOLMES EXECUTIVE DIRECTOR OF LIFECARE HOSPICE 40.00 0.00 X X 160170 0 15463 JODI HANNAN TEAM PHYSICIAN 40.00 0.00 X 105426 0 31984 SHARON POOLER PAST CHAIR 2.00 0.00 X X 0 0 0 ROSE SOLTZ CHAIR 2.00 0.00 X X 0 0 0 DAVID REYNOLDS VICE CHAIR 2.00 0.00 X X 0 0 0 JIM GEISER TREASURER 2.00 2.00 X X 0 0 0 JOHN MILLER BOARD MEMBER 2.00 0.00 X 0 0 0 KHANKEO KHOUNBORIN BOARD MEMBER 2.00 0.00 X 0 0 0 MONICA MIYASHITA BOARD MEMBER 2.00 0.00 X 0 0 0 RICHARD GUTTMAN BOARD MEMBER 2.00 0.00 X 0 0 0 TOM CIHA BOARD MEMBER 2.00 0.00 X 0 0 0 475589 719987 206456 3 0 1 0 SCENIC POINTE NURSING & REHAB 8067 TOWNSHIP ROAD 334 MILLERSBURG OH 44654 NURSING AND REHABILITATION SERVICES 355987 WEST VIEW MANOR INC 1715 MECHANICSBURG ROAD WOOSTER OH 44691 HEALTH CARE SERVICES 264278 SMITHVILLE WESTERN INC 3905 OBERLIN AVENUE LORAIN OH 44053 HEALTH CARE SERVICES 235393 PROGRESSIVE WOOSTER 1700 E SMITHVILLE WESTERN RD WOOSTER OH 44691 NURSING AND REHABILITATION SERVICES 222990 CASTLE NURSING HOMES INC 6180 STATE ROUTE 83 MILLERSBURG OH 44654 NURSING AND REHABILITATION SERVICES 221490 12 68394 618501 32666 686895 PATIENT SERVICE REVENUE 624100 11278579 11278579 11278579 345 345 1175 -1175 -1175 -1175 7500 68394 23545 -16045 -16045 CAFETERIA REVENUE 900099 14367 14367 MISCELLANEOUS REVENUE 900099 558 558 14925 11963524 11292946 0 -16317 417039 417039 6271465 5826436 374690 70339 250631 215539 35092 908314 792942 107152 8220 481359 421079 60148 132 3323 3323 4800 4800 16415 4631 11784 52235 1780 50333 122 501420 331700 166776 2944 231359 231359 285182 225656 59526 291684 260557 30760 367 43551 8437 35114 239532 239532 360511 328220 32291 45594 36038 8847 709 PATIENT SERVICE 1450752 1450752 ALLOCATION COSTS 852368 852368 ROOM & BOARD 251247 251247 DUES & SUBSCRIPTIONS 33163 11895 21268 126287 47132 46989 32166 13118231 10214041 2789191 114999 480798 845507 2711752 2032813 21428 35432 11418677 875519 10506081 10543158 250000 250000 0 110840 13970059 13817750 1412255 1761626 5781760 5512627 2310804 3094969 9504819 10369222 X 4455240 3334487 10000 114041 4465240 3448528 13970059 13817750 X -1154707 955 137041 X X 0 1 X 1 0 X 380121 541492 85286 657582 686895 2351376 380121 541492 85286 657582 686895 2351376 233249 2118127 22251 41738 30 62 345 64426 69342 51569 65579 -1714 8058 192834 2608636 49952575 0.81200 0.86040 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1155107 1155107 8780754 456774 8323980 412247 40005 372242 1050604 375722 674882 19965 3018 16947 10543158 PAYABLE TO RELATED PARTY 3094969 3094969 SPRING GALA 75894 68394 7500 0 0 1000 10181 40 12324 75894 68394 7500 1000 10181 40 12324 23545 -16045 0 0 0 0 0 0 0 1 0 KENT ANDERSON PRESIDENT & CEO - OHI 0 405900 0 66500 0 0 0 38348 0 25385 0 536133 0 0 CALVIN W ROBINSON CHIEF FINANCIAL OFFICER - OHI 0 222387 0 25200 0 0 0 38574 0 25289 0 311450 0 0 DAVID LANCE MEDICAL DIRECTOR LIFECARE HOSPICE 194318 0 15675 0 0 0 10300 0 21113 0 241406 0 0 0 KURT HOLMES EXECUTIVE DIRECTOR OF LIFECARE HOSPI 146670 0 13500 0 0 0 15463 0 0 0 175633 0 0 0 PART I, LINE 3 THE EXECUTIVE COMMITTEE OF THE OHI BOARD OF TRUSTEES UTILIZED LOCAL MARKET KNOWLEDGE, ANNUAL PERFORMANCE EVALUATIONS AND BENCHMARK DATA TO ESTABLISH COMPENSATION FOR THE CEO. THE COMPENSATION OF OTHER OFFICERS AND KEY EMPLOYEES IS ESTABLISHED BY THE CEO UNDER GUIDELINES ESTABLISHED BY OHI AND AFFILIATE BOARDS OF TRUSTEES AS PART OF THE BUDGET PROCESS. PART I, LINE 7 THE BOARD OF DIRECTORS CONDUCTS AN ANNUAL PERFORMANCE REVIEW TO DETERMINE THE COMPENSATION AND BENEFITS OF THE CEO. IN ADDITION TO NORMAL COMPENSATION AND BENEFITS, THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS MAY ALSO AWARD BONUS COMPENSATION TO THE CEO BASED UPON THE ANNUAL PERFORMANCE REVIEW. THE CEO CONDUCTS AN ANNUAL PERFORMANCE REVIEW OF THE OTHER OFFICERS AND EMPLOYEES TO DETERMINE THEIR COMPENSATION AND BENEFITS. IN ADDITION TO NORMAL COMPENSATION AND BENEFITS, THE CEO, WITH THE APPROVAL OF THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS, MAY ALSO AWARD BONUS COMPENSATION TO THE OTHER OFFICERS AND EMPLOYEES BASED UPON THEIR ANNUAL PERFORMANCE REVIEW. X 1 4220 FAIR MARKET VALUE X HEARING AIDS 26 13800 FAIR MARKET VALUE X FURNITURE 1 7000 FAIR MARKET VALUE X MASSAGE EQUIPMENT 1 3471 FAIR MARKET VALUE X LEGAL WORK 1 1750 FAIR MARKET VALUE X EVENT VENUE DISCOUNT 1 1000 FAIR MARKET VALUE X PUMP 1 925 FAIR MARKET VALUE 0 0 0 FORM 990, PART VI, SECTION A, LINE 6 OHIO'S HOSPICE, INC BECAME THE SOLE MEMBER OF LIFECARE HOSPICE WITH AN AFFILIATION AGREEMENT SIGNED IN JUNE 2017. FORM 990, PART VI, SECTION A, LINE 7A OHIO'S HOSPICE INC. HAS THE POWER TO APPOINT THE BOARD OF DIRECTORS. THE BOARD SHALL RECOMMEND INDIVIDUALS TO FILL ANY OPENINGS. OHIO'S HOSPICE HAS THE RIGHT TO ELECT FROM THESE INDIVIDUALS OR OTHER INDIVIDUALS AT ITS DISCRETION. FORM 990, PART VI, SECTION A, LINE 7B OHIO'S HOSPICE INC. RETAINS THE POWER TO AMEND THE ARTICLES OF INCORPORATION, CODE OF REGULATIONS, ETC. OF THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 WAS PREPARED BY AN OUTSIDE ACCOUNTING FIRM AND REVIEWED BY THE CFO PRIOR TO BEING FILED WITH THE INTERNAL REVENUE SERVICE. THE FORM 990 IS SENT VIA EMAIL TO THE FULL BOARD AND WILL BE REVIEWED IN SESSION BY THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS AT THEIR NEXT MEETING. FORM 990, PART VI, SECTION B, LINE 12C IN THE EVENT ANY DIRECTOR, OFFICER OR EXECUTIVE OF THE ORGANIZATION SHALL HAVE ANY DIRECT OR INDIRECT INTEREST IN OR RELATIONSHIP WITH ANY INDIVIDUAL OR ORGANIZATION THAT PROPOSES TO ENTER INTO ANY TRANSACTION WITH THE ORGANIZATION FOR THE SALE, PURCHASE, LEASE OR RENTAL OF PROPERTY OR TO RENDER OR EMPLOY SERVICES, PERSONAL OR OTHERWISE, SUCH DIRECTOR, OFFICER OR EXECUTIVE SHALL FORTHWITH GIVE THE BOARD OF DIRECTORS, CHAIR OF THE BOARD OR PRESIDENT OF THE ORGANIZATION NOTICE OF SUCH INTEREST OR RELATIONSHIP AND SHALL THEREAFTER NOT BE COUNTED FOR THE PURPOSE OF DETERMINING A QUORUM AND SHALL REFRAIN FROM VOTING OR OTHERWISE ATTEMPTING TO AFFECT ITS DECISION TO PARTICIPATE IN SUCH TRANSACTION. IN THE EVENT THAT A CHALLENGE OR QUESTION IS RAISED WHETHER CONFLICT OR DUALITY OF INTEREST EXISTS, THE BOARD OR CHAIR OF THE BOARD OF THE ORGANIZATION SHALL DETERMINE THAT A DUALITY OF INTEREST EXISTS (BY A 2/3 VOTE OF THE BODY). MINUTES OF APPROPRIATE MEETINGS SHOULD REFLECT THAT SUCH DISCLOSURE WAS MADE, AND THAT SUCH DIRECTOR REMOVED HIMSELF/HERSELF FROM THE ROOM AND DID NOT PARTICIPATE IN THE FINAL DISCUSSION, AND WAS NOT COUNTED FOR THE PURPOSE OF DETERMINING A QUORUM. THE CONFLICT OF INTEREST STATEMENT SHALL BE REVIEWED ANNUALLY FOR THE INFORMATION AND GUIDANCE OF DIRECTORS, OFFICERS OR EXECUTIVES AND THAT ANY NEW DIRECTORS, OFFICERS OR EXECUTIVES BE ADVISED OF THE POLICY UPON UNDERTAKING THE DUTIES OF SUCH OFFICE. FORM 990, PART VI, SECTION B, LINE 15 THE EXECUTIVE COMMITTEE OF THE OHI BOARD OF TRUSTEES UTILIZED LOCAL MARKET KNOWLEDGE, ANNUAL PERFORMANCE EVALUATIONS AND BENCHMARK DATA TO ESTABLISH COMPENSATION FOR THE CEO. THE COMPENSATION OF OTHER OFFICERS AND KEY EMPLOYEES IS ESTABLISHED BY THE CEO UNDER GUIDELINES ESTABLISHED BY OHI AND AFFILIATE BOARDS OF TRUSTEES AS PART OF THE BUDGET PROCESS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON WRITTEN REQUEST. FORM 990, PART XI, LINE 9: RESTRICTED CONTRIBUTIONS 135,795. NET CHANGE IN FAIR VALUE OF PERPETUAL TRUST 1,246. COMMUNITY CARE HOSPICE INC PO BOX 123 WILMINGTON OH 45177 371495725 TO PROVIDE HOSPICE CARE OH 501(C)(3) LINE 7 OHIO'S HOSPICE INC 1 FOUNDATION FOR HOSPICE OF CENTRAL OHIO 2269 CHERRY VALLEY ROAD NEWARK OH 43055 550855205 TO PROVIDE FINANCIAL SUPPORT TO ITS PARENT, HOSPICE OF CENTRAL OHIO OH 501(C)(3) LINE 12A, I HOSPICE OF CENTRAL OHIO 1 HOSPICE OF CENTRAL OHIO 2269 CHERRY VALLEY ROAD NEWARK OH 43055 311059756 TO PROVIDE HOSPICE CARE OH 501(C)(3) LINE 7 OHIO'S HOSPICE INC 1 HOSPICE OF DAYTON FOUNDATION 7575 PARAGON ROAD DAYTON OH 45459 311769696 TO PROVIDE FINANCIAL SUPPORT TO ITS PARENT, HOSPICE OF DAYTON OH 501(C)(3) LINE 12A, I HOSPICE OF DAYTON INC 1 HOSPICE OF DAYTON INC 7575 PARAGON ROAD DAYTON OH 45459 310933339 TO PROVIDE HOSPICE CARE OH 501(C)(3) LINE 7 OHIO'S HOSPICE INC 1 HOSPICE OF MIAMI COUNTY INC 550 SUMMIT AVENUE TROY OH 45373 311031277 TO PROVIDE HOSPICE CARE OH 501(C)(3) LINE 7 OHIO'S HOSPICE INC 1 OHIO'S HOSPICE INC 7575 PARAGON ROAD DAYTON OH 45459 463215586 TO PROVIDE MANAGEMENT SERVICES AS A SUPPORTING ORGANIZATION OH 501(C)(3) LINE 12A, I N/A 0 LOVING CARE HOSPICE PO BOX 445 LONDON OH 43140 311370625 TO PROVIDE HOSPICE CARE OH 501(C)(3) LINE 10 OHIO'S HOSPICE INC 1 HOSPICE OF FAYETTE COUNTY 222 N OAKLAND AVE WASHINGTON COURTHOUSE OH 43160 311243376 TO PROVIDE HOSPICE CARE OH 501(C)(3) LINE 7 OHIO'S HOSPICE INC 1 NATIONAL HOSPICE COOPERATIVE 324 WILMINGTON AVE DAYTON OH 45420 832087147 BUSINESS SUPPORT OH N/A C 1 0 0 0 0 1 0 0 0 0 0 0 0 1 0 1 1 0 0 0